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常温机械灌注技术在离断肢体保存中的作用研究进展

贾志博, 管延军, 宋翔宇, 等. 常温机械灌注技术在离断肢体保存中的作用研究进展[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2024062
引用本文: 贾志博, 管延军, 宋翔宇, 等. 常温机械灌注技术在离断肢体保存中的作用研究进展[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2024062
Jia Zhibo, Guan Yanjun, Song Xiangyu, et al. Research progress on the role of normothermic machine perfusion in the preservation of severed limbs[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024062
Citation: Jia Zhibo, Guan Yanjun, Song Xiangyu, et al. Research progress on the role of normothermic machine perfusion in the preservation of severed limbs[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024062

常温机械灌注技术在离断肢体保存中的作用研究进展

doi: 10.3969/j.issn.1674-7445.2024062
基金项目: 国家重点研发计划(2019YFA0110704);解放军总医院青年自主创新科学基金项目(22QNFC014)
详细信息
    作者简介:
    通讯作者:

    彭江(ORCID 0000 0003 4662 9288),主任医师,教授,博士研究生导师,研究方向为股骨头坏死保髋治疗、关节软骨损伤修复、周围神经损伤修复、离断肢体保存及骨科康复治疗,Email:pengjiang301@126.com

  • 中图分类号: R617, R658

Research progress on the role of normothermic machine perfusion in the preservation of severed limbs

More Information
  • 摘要: 肢体离断伤在临床工作中较为常见,对离断肢体实施安全有效的保护是肢体再植成功的关键。常温机械灌注技术已经在器官移植领域取得很大突破,可长时间维持器官和组织的活性功能,延长其保存时间,在大动物模型以及临床应用中得到了很好的验证。同时这项技术有望为离断肢体的保存和功能恢复提供新的参考。因此,本文就静态冷保存在离断肢体保存中存在的问题、机械灌注的发展历程、离断肢体常温机械灌注的临床应用现状以及有待解决问题进行综述,并展望其发展方向和临床应用前景,以期推动该技术在临床广泛应用。

     

  • [1] 邵能琪, 冯凡哲, 崔轶. 离断肢(指)体保存方法的研究进展[J]. 中华显微外科杂志, 2023, 46(6): 709-714. DOI: 10.3760/cma.j.cn441206-20230421-00074.

    SHAO NQ, FENG FZ, CUI Y. Progress in research on methods for severed limb (digit) preservation[J]. Chin J Microsurg, 2023, 46(6): 709-714. DOI: 10.3760/cma.j.cn441206-20230421-00074.
    [2] REZAEI M, ORDENANA C, FIGUEROA BA, et al. Ex vivo normothermic perfusion of human upper limbs[J]. Transplantation, 2022, 106(8): 1638-1646. DOI: 10.1097/TP.0000000000004045.
    [3] DURAES EFR, MADAJKA M, FRAUTSCHI R, et al. Developing a protocol for normothermic ex-situ limb perfusion[J]. Microsurgery, 2018, 38(2): 185-194. DOI: 10.1002/micr.30252.
    [4] PAVAN-GUIMARAES J, ZARRINPAR A, BEDUSCHI T, et al. Machine perfusion organ preservation: highlights from the American Transplant Congress 2021[J]. Artif Organs, 2022, 46(2): 315-320. DOI: 10.1111/aor.14100.
    [5] BOTEON YL, ANGELICO R, BUCHHOLZ BM, et al. Machine perfusion organ preservation: highlights from the American Transplant Congress 2022[J]. Artif Organs, 2023, 47(1): 222-227. DOI: 10.1111/aor.14448.
    [6] HAUG V, DIEHM YF, KNESER U, et al. Some like it hot-a commentary to ex vivo normothermic perfusion of human upper limbs[J]. Transplantation, 2022, 106(8): 1522-1523. DOI: 10.1097/TP.0000000000004046.
    [7] LÓPEZ-MARTÍNEZ S, SIMÓN C, SANTAMARIA X. Normothermic machine perfusion systems: where do we go from here?[J]. Transplantation, 2024, 108(1): 22-44. DOI: 10.1097/TP.0000000000004573.
    [8] MEYERS A, PANDEY S, KOPPARTHY V, et al. Weight gain is an early indicator of injury in ex vivo normothermic limb perfusion (EVNLP)[J]. Artif Organs, 2023, 47(2): 290-301. DOI: 10.1111/aor.14442.
    [9] FIGUEROA BA, SAID SA, ORDENANA C, et al. Ex vivo normothermic preservation of amputated limbs with a hemoglobin-based oxygen carrier perfusate[J]. J Trauma Acute Care Surg, 2022, 92(2): 388-397. DOI: 10.1097/TA.0000000000003395.
    [10] AMIN KR, STONE JP, KERR JC, et al. Normothermic ex vivo perfusion of the limb allograft depletes donor leukocytes prior to transplantation[J]. J Plast Reconstr Aesthet Surg, 2021, 74(11): 2969-2976. DOI: 10.1016/j.bjps.2021.03.071.
    [11] FOGUENNE M, MACMILLAN S, KRON P, et al. Current evidence and future perspectives to implement continuous and end-ischemic use of normothermic and oxygenated hypothermic machine perfusion in clinical practice[J]. J Clin Med, 2023, 12(9): 3207. DOI: 10.3390/jcm12093207.
    [12] JOCHMANS I, HESSHEIMER AJ, NEYRINCK AP, et al. Consensus statement on normothermic regional perfusion in donation after circulatory death: report from the European Society for Organ Transplantation’s Transplant Learning Journey[J]. Transpl Int, 2021, 34(11): 2019-2030. DOI: 10.1111/tri.13951.
    [13] WANG L, MACGOWAN GA, ALI S, et al. Ex situ heart perfusion: the past, the present, and the future[J]. J Heart Lung Transplant, 2021, 40(1): 69-86. DOI: 10.1016/j.healun.2020.10.004.
    [14] HAUG V, KOLLAR B, TASIGIORGOS S, et al. Hypothermic ex situ perfusion of human limbs with acellular solution for 24 hours[J]. Transplantation, 2020, 104(9): e260-e270. DOI: 10.1097/TP.0000000000003221.
    [15] MESSNER F, HAUTZ T, BLUMER M JF, et al. Critical ischemia times and the effect of novel preservation solutions HTK-N and TiProtec on tissues of a vascularized tissue isograft[J]. Transplantation, 2017, 101(9): e301-e310. DOI: 10.1097/TP.0000000000001845.
    [16] HE J, KHAN UZ, QING L, et al. Improving the ischemia-reperfusion injury in vascularized composite allotransplantation: clinical experience and experimental implications[J]. Front Immunol, 2022, 13: 998952. DOI: 10.3389/fimmu.2022.998952.
    [17] ALIX P, VAL-LAILLET D, TURLIN B, et al. Adding the oxygen carrier M101 to a cold-storage solution could be an alternative to HOPE for liver graft preservation[J]. JHEP Rep, 2020, 2(4): 100119. DOI: 10.1016/j.jhepr.2020.100119.
    [18] CAO M, WANG G, HE H, et al. Hemoglobin-based oxygen carriers: potential applications in solid organ preservation[J]. Front Pharmacol, 2021, 12: 760215. DOI: 10.3389/fphar.2021.760215.
    [19] OSTRÓŻKA-CIEŚLIK A. The effect of antioxidant added to preservation solution on the protection of kidneys before transplantation[J]. Int J Mol Sci, 2022, 23(6): 3141. DOI: 10.3390/ijms23063141.
    [20] SCHLEGEL A, PORTE R, DUTKOWSKI P. Protective mechanisms and current clinical evidence of hypothermic oxygenated machine perfusion (HOPE) in preventing post-transplant cholangiopathy[J]. J Hepatol, 2022, 76(6): 1330-1347. DOI: 10.1016/j.jhep.2022.01.024.
    [21] BELZER FO, ASHBY BS, GULYASSY PF, et al. Successful seventeen-hour preservation and transplantation of human-cadaver kidney[J]. N Engl J Med, 1968, 278(11): 608-610. DOI: 10.1056/NEJM1968 03142781108.
    [22] BLOOM AL. Activation of coagulation and fibrinogen loss after using an extracorporeal circulation[J]. J Clin Pathol, 1963, 16(6): 558-568. DOI: 10.1136/jcp.16.6.558.
    [23] BRETTSCHNEIDER L, DALOZE PM, HUGUET C, et al. Successful orthotopic transplantation of liver homografts after eight to twenty-five hours preservation[J]. Surg Forum, 1967, 18: 376-378.
    [24] DELORME TL, SHAW RS, AUSTEN WG. A method of studying “normal” function in the amputated human limb using perfusion[J]. J Bone Joint Surg Am, 1964, 46: 161-164. DOI: 10.2106/00004623-196446010-00018.
    [25] O’DONOVAN MJ, ROWLERSON A, TAYLOR A. Proceedings: The perfused isolated human limb: an assessment of its viability[J]. J Physiol, 1976, 256(1): 27P-28P.
    [26] GAO J, HE K, XIA Q, et al. Research progress on hepatic machine perfusion[J]. Int J Med Sci, 2021, 18(9): 1953-1959. DOI: 10.7150/ijms.56139.
    [27] 中国肝移植注册中心, 国家肝脏移植质控中心, 国家人体捐献器官获取质控中心, 等. 中国移植器官保护专家共识(2022版)[J]. 中华消化外科杂志, 2022, 21(2): 169-184. DOI: 10.3760/cma.j.cn115610-20220214-00078.

    China Liver Transplant Registry, National Center for Healthcare Quality Management in Liver Transplant, National Quality Control Center for Human Donated Organ Procurement, et al. Chinese expert consensus on organ protection of transplantation (2022 edition) [J]. Chin J Dig Surg, 2022, 37(5): 387-394. DOI: 10.3760/cma.j.cn113855-20220308-00135.
    [28] AMIN KR, STONE JP, KERR J, et al. Randomized preclinical study of machine perfusion in vascularized composite allografts[J]. Br J Surg, 2021, 108(5): 574-582. DOI: 10.1002/bjs.11921.
    [29] OZER K. Advances in limb preservation: from replantation to transplantation[J]. J Hand Surg Am, 2020, 45(7): 626-637. e5. DOI: 10.1016/j.jhsa.2020.04.006.
    [30] 汪恺,苏仁义,王周城, 等. “机械灌注+”视阈下扩大标准供肝的修复与功能提升[J]. 中华消化外科杂志, 2022, 21(1): 74-78. DOI: 10.3760/cma.j.cn115610-20211220-00668.

    WANG K, SU RY, WANG ZC, et al. Extended criteria donor reconditioning and functional improvement in the viewshed of machine perfusion plus[J]. Chin J Dig Surg, 2022, 21(1): 74-78. DOI: 10.3760/cma.j.cn115610-20211220-00668.
    [31] RIVEROS S, MARINO C, OCHOA G, et al. Customized normothermic machine perfusion decreases ischemia-reperfusion injury compared with static cold storage in a porcine model of liver transplantation[J]. Artif Organs, 2023, 47(1): 148-159. DOI: 10.1111/aor.14390.
    [32] KALTENBORN A, KREZDORN N, HOFFMANN S, et al. Ex vivo limb perfusion for traumatic amputation in military medicine[J]. Mil Med Res, 2020, 7(1): 21. DOI: 10.1186/s40779-020-00250-y.
    [33] VERAZA RJ, LOPEZ R, PARRY O, et al. Proof of concept study for a closed ex vivo limb perfusion system for 24-hour subnormothermic preservation using acellular perfusate[J]. J Trauma Acute Care Surg, 2022, 93(2S Suppl 1): S102-S109. DOI: 10.1097/TA.0000000000003688.
    [34] FIGUEROA BA, ORDENANA CX, REZAEI M, et al. Orthotopic forelimb transplantation in a Yucatan minipig model: anatomic and in vivo study[J]. Microsurgery, 2024, 44(2): e31136. DOI: 10.1002/micr.31136.
    [35] YAMAMOTO T, ATTHOTA S, AGARWAL D, et al. Impact of portable normothermic machine perfusion for liver transplantation from adult deceased donors[J]. Ann Surg, 2023, 278(5): e922-e929. DOI: 10.1097/SLA.0000000000006032.
    [36] UNES M, KURASHIMA K, CALISKAN Y, et al. Normothermic ex vivo perfusion of deceased donor kidneys and its clinical potential in kidney transplantation outcomes[J]. Int J Artif Organs, 2023, 46(12): 618-628. DOI: 10.1177/03913988231207719.
    [37] MESSER S, ARDEHALI A, TSUI S. Normothermic donor heart perfusion: current clinical experience and the future[J]. Transpl Int, 2015, 28(6): 634-642. DOI: 10.1111/tri.12361.
    [38] CONSTANTINESCU MA, KNALL E, XU X, et al. Preservation of amputated extremities by extracorporeal blood perfusion; a feasibility study in a porcine model[J]. J Surg Res, 2011, 171(1): 291-299. DOI: 10.1016/j.jss.2010.01.040.
    [39] FAHRADYAN V, SAID SA, ORDENANA C, et al. Extended ex vivo normothermic perfusion for preservation of vascularized composite allografts[J]. Artif Organs, 2020, 44(8): 846-855. DOI: 10.1111/aor.13678.
    [40] SAID SA, ORDEÑANA CX, REZAEI M, et al. Ex-vivo normothermic limb perfusion with a hemoglobin-based oxygen carrier perfusate[J]. Mil Med, 2020, 185(Suppl 1): 110-120. DOI: 10.1093/milmed/usz314.
    [41] STONE JP, AMIN KR, GERAGHTY A, et al. Renal hemofiltration prevents metabolic acidosis and reduces inflammation during normothermic machine perfusion of the vascularized composite allograft: a preclinical study[J]. Artif Organs, 2022, 46(2): 259-272. DOI: 10.1111/aor.14089.
    [42] CHEN SF, YANG BY, ZHANG TY, et al. Study on the preservation effects of the amputated forelimb by machine perfusion at physiological temperature[J]. Chin J Traumatol, 2024, 27(2): 114-120. DOI: 10.1016/j.cjtee.2023.05.005.
    [43] ROHDE E, GOUDARZI M, MADAJKA M, et al. Metabolic profiling of skeletal muscle during ex-vivo normothermic limb perfusion[J]. Mil Med, 2021, 186(Suppl 1): 358-363. DOI: 10.1093/milmed/usaa268.
    [44] 李颖, 王国军, 蒋继亮, 等. 体外循环辅助下的大肢体再植技术(附1例报道)[J]. 中国骨与关节损伤杂志, 2014, 29(9): 954-955. DOI: 10.7531/j.issn.1672-9935.2014.09.043.

    LI Y, WANG GJ, JIANG JL, et al. Replantation of large limbs assisted by cardiopulmonary bypass (report of one case)[J]. Chin J Bone Jt Inj, 2014, 29(9): 954-955. DOI: 10.7531/j.issn.1672-9935.2014.09.043.
    [45] 方凯凯, 李颖, 王春书, 等. 体外循环支持下离断大肢体再植手术[J]. 中国体外循环杂志, 2015, 13(1): 55-56. DOI: 10.13498/j.cnki.chin.j.ecc.2015.01.16.

    FANG KK, LI Y, WANG CS, et al. Reservation of amputated extremities asisted by extracorporeal circulation[J]. Chin J Extracorpor Circ, 2015, 13(1): 55-56. DOI: 10.13498/j.cnki.chin.j.ecc.2015.01.16.
    [46] 李颖, 闫浩, 蒋继亮, 等. 灌注技术在上肢离断再植术中的应用[C]//第23届中国康协肢残康复学术年会暨换届会议论文汇编. 南京, 2017: 57.
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  • 收稿日期:  2024-04-20
  • 网络出版日期:  2024-07-08

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